Tip of the Week: Cramps (AKA – Stitches)

What do you do if you experience a stitch while running? Unfortunately, runners are prone to developing cramps, (AKA- Stitches) in their upper abdominal regions. Stitches typically occur in the latter stages of either a workout or race (especially with increased efforts). The main culprit: the diaphragm, which is the primary muscle involved in breathing. Traditionally, it was believed that stitches occurred when individuals would try to run too soon after consuming a significant amount of food or liquid. I believe this can be true but only in conjunction with another key factor. If you think about it, cyclists, swimmers, skiers, etc., all place huge demands on their respiratory system (their diaphragm), intake large quantities of food and liquid before and during their activity and seldom develop cramps. So what differentiates running from all of these other sports, and what makes us so much more susceptible to developing abdominal pains?

Well, the answer is easy: IMPACT. When we run the organs inside of our abdominal cavity (liver, stomach, spleen, etc.) bounce up and down like puppets on a string. The “string” is connective tissue, which attaches our organs to our diaphragm. With each foot strike (impact) the organs ascend in the abdominal cavity and then quickly descend. The diaphragm, which also moves up and down with each inhalation and exhalation, can either move in sync or out of sync with our organs. Picture this: as we inhale the diaphragm moves downward, moving in the same direction as our organs, minimizing the forces in our abdominal cavity that occur with impact. As we exhale, the diaphragm moves upward, moving in the opposite direction of our organs, maximizing the forces in our abdominal cavity that occur with impact and thus causing our diaphragm to spasm, creating a painful stitch. Make sense so far?

The majority of stitches occur on the right side of the abdomen. Why? That is where the heaviest organ in the abdominal cavity, the liver, is located. To stop stitches from occurring you need to keep in mind that stitches are a function of ground impact and breathing. The chances of a stitch are maximized when foot strike and exhalation are synchronized on one side of the body. For example, if you exhale as your right foot strikes the ground, your diaphragm is in the up position. Your liver then comes crashing downward creating an increased force on the diaphragm and increasing your chances of developing a right sided stitch. This would not be a problem if breathing occurred somewhat randomly, but most runners coordinate their breathing patterns with striding. Repetition of stride can create an immense pressure on the diaphragm, which can result in a painful spasm.

So what can we do? When you feel a stitch beginning to strike, change your breathing pattern immediately. If the stitch is on the right side, start exhaling when your left foot strikes the ground, and vice versa. Prevention is always the best treatment, so here are a few ways to avoid those unpleasant stitches from rearing their ugly heads:

  1. Alternate your breathing pattern.
  2. Tell jokes and laugh a lot before a race (I’m serious). Increased stress before a race can cause the diaphragm to tighten up. Laughing stretches the diaphragm, which may help reduce the risk of stitching during a race. This is a great technique for those who are prone to stitches.
  3. Strengthen your abdominal muscles. Increased abdominal strength helps support our internal organs and keeps them from excessive excursions.
  4. For those who are prone to left-side stitches, try to reduce the amount of liquid and food intake 2 hours prior to a race. Eating too much too close to the start of a race will increase the weight of the stomach, which will in turn increase the amount of force placed on the diaphragm.

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